My Practice

A recent training exchange visit to India posed several
questions on the relevance of concepts such as child mental health
and the applicability of western types of interventions and
services.

Spending time with staff and clients was a privilege. They
tested one’s pre-conceived ideas on what constitute child mental
health problems, why these develop, and how children with
substantially different upbringing and experiences communicate
them. This being my second attempt, following a similar visit to
Gaza in Palestine, I was not very surprised by the similarities in
the factors that lead to mental health problems.

Admittedly the presentation varied, but the underlying reasons
for emotional and behavioural problems usually involved some kind
of acute stressor or chronic adversity in the child’s environment,
accounting for what were accepted as the social, cultural and
spiritual or religious norms (such as family roles, parenting or
peer relationships).

This understanding and interpretation is important in deciding
on the best way of developing realistic but effective mental health
services for children and young people. There is no doubt that we
should continue to strive towards redressing as much of the
financial imbalance as possible, while supporting developing
countries in establishing their own sustainable health and welfare
systems.

However, one has to accept that there will be other urgent
health priorities for years to come such as sanitation, nutrition
and immunisations. Inevitably, the scope for specialist services
will remain limited. It would also be wrong to drive national
policies and limited resources simply by adapting western service
models.

A recent review of health projects in the developing world
indicated that the most successful ones acknowledged local societal
strengths, and maximised the input of existing community supports
and networks, for example by training volunteers in rural areas. A
large proportion of these projects were steered by national or
international NGOs and charities.

In relation to children, schools are another obvious focal point
for mental health promotion and interventions. This was
particularly obvious in India, as it was strengthened by parents’
high value of education, even in very deprived areas.

The more we consider underlying principles such as family and
community ties in enhancing children’s emotional and social
well-being in other countries, the more we might appreciate their
value in western society, where the role of the public sector,
mainly in urban areas, is often to compensate for or replace rather
than complement such ties.

Panos Vostanis is consultant child and adolescent
psychiatrist with the Leicestershire Partnership Trust’s young
people’s team, and professor of child psychiatry at the University
of Leicester.